Provider Demographics
NPI:1922104090
Name:COLIN R CADDELL DC PA
Entity Type:Organization
Organization Name:COLIN R CADDELL DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-294-1273
Mailing Address - Street 1:3608 W FRIENDLY AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4865
Mailing Address - Country:US
Mailing Address - Phone:336-294-1273
Mailing Address - Fax:336-294-1274
Practice Address - Street 1:3608 W FRIENDLY AVE
Practice Address - Street 2:STE 204
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4865
Practice Address - Country:US
Practice Address - Phone:336-294-1273
Practice Address - Fax:336-294-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244330BMedicare PIN
NCT64381Medicare UPIN